Alice Sanvito is a massage therapist trained in trigger point massage, remedial and sports massage. After several years practicing & lecturing the concepts she learnt she began challenging her own beliefs and following the science. Today we cover: Are there benefits to promoting blood circulation, and removing lactic acid? Does massage help with muscle lengthening & knots? What is the mechanism behind trigger point therapy? What traps should runners avoid when injured? When is there a place for a runner to receive massage therapy? For 20% off to the RunChatLive conference including all the live recordings, use RUNSMARTER20 at checkout learn more here If you would like to support the podcast, participate in Q&As & access bonus material sign up for $5US per month at our patreon page For Brodie's running blogs, podcast episodes and online courses visit our Run Smarter Website To follow the podcast joint the facebook group Becoming a smarter runner To find Brodie's running information on instagram @runsmarterseries
Expand your running knowledge, identify running misconceptions and become a faster, healthier, SMARTER runner. Let Brodie Sharpe become your new running guide as he teaches you powerful injury insights from his many years as a physiotherapist while also interviewing the best running gurus in the world. This is ideal for injured runners & runners looking for injury prevention and elevated performance. So, take full advantage by starting at season 1 where Brodie teaches you THE TOP PRINCIPLES TO OVERCOME ANY RUNNING INJURY and let’s begin your run smarter journey.
:
On today's episode, the good and bad of massage therapy with Alice Sanvito. Welcome to the Run Smarter podcast. The podcast helping you overcome your current and future running injuries by educating and transforming you into a healthier, stronger, smarter runner. If you're like me, running is life, but more often than not, injuries disrupt this lifestyle. And once you are injured, you're looking for answers. and met with bad advice and conflicting messages circulating the running community. The world shouldn't be like this. You deserve to run injury free and have access to the right information. That's why I've made it my mission, to bring clarity and control to every runner. My name is Brodie Sharp, I am a physiotherapist, a former chronic injury sufferer and your podcast host. I am excited that you have found this podcast and by default become the Run Smarter Scholar. So let's work together to overcome your injury, restore your confidence and start spreading the right information back into your running community. So let's begin today's lesson. Okay, we have a good one today. I have surprised myself that we haven't covered massage therapy yet, but we have now. We have Alice San Vito in the house today. Big thanks to my Patreon supporters for jumping on and having their input once again. They have been kind enough to give me some feedback. I sent out a question asking why they get massage therapy, what they think it helps with, and what they've been told or what they believe. massage therapy helps with. Thanks to Jill who says that it helps dissociate from the work and life balance. She feels relaxed and less tense and the massage itself just feels good and has been told in the past that it promotes circulation, decreases muscle tension and decreases pain. Vanessa usually gets massaged to relieve tight knots, tight muscles, and holds a lot of stress in her body and she's been told that it helps with lactic acid build-up. Steve gets tight neck muscles and from just general stress at work and massaged helps with that and along the similar lines we're seeing a bit of a pattern around promoting circulation, decreasing pain, decreasing muscle tension. Addressing muscle knots all that sort of thing. So we're gonna touch based on all that today, which I'm super excited about I'm super excited to deliver this key knowledge to you And thanks again once to those patreon supporters. I released my first exclusive patreon episode this week So I was pumped about that and addressing talking to the group and it's hard for me to know who I'm addressing to when I release a generic episode because there's thousands of you out there that I don't know who you are, but yeah, so it was a good, nice change of pace. The episode that I did release was identifying the warning signs or any alarms that might a new injury might be arising or what symptoms to pay attention to that might develop into an injury. So recognizing, interpreting, detecting these signs. Alice in a couple of weeks time, I think next week by the time this gets released is partaking in the Run Chat Live Conference. It is... produced by the Run Chat Live podcast by Matt Phillips, who organizes and hosts the podcast and organizes this conference. So I had to reach out to him and said, hey, I'm getting Alice to come on board. I'd love to do a shout out for your conference. And because I attended it last year and just love the work that he does. And he was generous enough without me even asking for giving you guys a discount code. So what this conference is, is a whole bunch of mainly researchers and health professionals talking about all the latest research, the latest evidence when it comes to runners. So it's right up your alley if you listen to this podcast. When I have listened to, when I attended last year's conference, it was quite technical. They go through articles, they go through evidence and some of it can be a bit overwhelming or a bit technical when it comes to just everyday runner knowledge. So there is a bit of technicalities in there, a bit of jargon thrown around, but if you love this podcast, you'd love that conference. Let me look up because the discount code is runSmartR20 and it'll give you 20% off. And I'll include the link in the show notes that will give you access to this. So the dates are the 29th and 30th of October, so very soon next week. It is available in English and in Spanish, if you prefer the Spanish alternative. The guests, the guest speakers, Alice, we have Matt Fitzgerald, we have Kevin Maggs, who was on this podcast. We have Mike James, who I refer to constantly for strength and conditioning. We have Tom Goom, who is the absolute legend when it comes to running injuries and breaking down a lot of concepts and the latest evidence. A lot of the stuff I've learned has come from Tom Goom. And yeah, a packed jam full of top quality, top tier, world-class guest speakers. So yeah, I'm pumped to... let you know about it and if you want to get 20% off then you can just click on the link below and yeah you will you can attend it live it will be virtual so you can attend them for the live interactions and Q&As and all that sort of stuff but with this discount code you can also receive all of the recordings which is what I did last year so I purchased it after the live event and then just listened in my own time to all of these listeners jot down my notes, pause when I need to pause, write down what I've learnt and yeah, I found that a really, really good way, a good addition to what is usually a live conference and you just have to jot everything down and hope you catch everything. So having those recordings is really, really good. I think that's all I need to say about that conference. I highly, highly recommend it. Yeah, so without further ado, we'll talk, we'll bring on Alice and we'll talk about massage therapy. We're going to break down a whole bunch of concepts. We're going to break down a whole bunch of beliefs that you might have around massage therapy, and we're going to also add in some good stuff as well. So yeah, enjoy it. It's a bit of a long one, but worth it. So here is Alice Okay. Um, so let's get started. Alice, it's a pleasure to have you on today. The concept of massage and massage therapy is a topic that I haven't covered at all on this podcast in the 75 episodes that I have. And runners do often require or think they require massage therapy techniques. And I did ask my Patreons around what their beliefs are and what they think is happening with massage therapy. So excited to dive into a couple of the concepts today. So let me start by saying, welcome Alex, welcome to the podcast. Well, thank you very much. And I'm really excited about this. And that's interesting that it's taken a while for this to come up because I'm just waiting for the right person, Alice. That's the thing. Yeah. Well, I hope I, I hope I filled the bill and I'm very curious to hear what they have to say about it and what they're being told. And, um, what their experience is. So yeah, no, this sounds like a lot of fun. I'm sure it's nothing that you haven't heard before, but before we dive into that side of things, how about we just talk about, first of all, your background and how you found yourself into massage therapy? Well, I came into it late in life. I was 40 years old when I came into it. And just to put me in context, I'm in Midwestern United States. I began practicing in 1991. And at the time we had no state licensing, less than half the states had licensing. So there were very, there were no requirements, but I'm the kind of person I'm always seeking out the best teachers I can find. So I found a school that offered the most comprehensive curriculum at the time. And then as soon as I got out of school, I started studying remedial massage. So my first class was in sports massage. At the time I wasn't that interested in sports or sports massage, but I was interested in injury rehabilitation. And I thought that would be a good place to start. And then I started working with athletes. They just started showing up and I found I really enjoyed working with that population. Um, they tended to be very upbeat and had a very can do attitude. And, uh, so I ended up doing a lot of sports massage. But since then, so that would have been in 1991. I just dove right in. I started studying trigger point therapy and ended up within a couple of years assisting at seminars where they taught that. And so I assisted at those seminars for 10 years. I was very, very steeped in it. And I also started studying with the Russian massage therapist, Zhenya Korochova-Wine. massage in their hospitals and clinics and with their sports teams. And they were very serious about it. And I traveled with her to Russia and Latvia to see how they used it there. Um, and just really, I, you know, I, I took gross anatomy, doing dissecting cadavers, um, and studied under the, the professor of anatomy at St. Louis university medical school. The class wasn't at the medical school. It was at an outside facility where he taught non-medical students. So I just have had, you know, 28 years of experience and a lot of continuing education. And from the beginning, I was very interested in the science of massage and tried to find people who were science-based because my education definitely was not. Very cool. And can I ask, like, if you were to have these, the trainings in sports massage, remedial massage, like this trigger point therapy, when you were to see an athlete and they were, they might've been injured or wanting to enhance recovery, those sort of things, during your training, were you, did you instill a certain belief or were you trained to have a certain belief in terms of what massage was doing? Um, my initial training didn't very much. I mean, I don't know if people even really thought about it, you know, they just was like, it feels good. Um, so that was kind of good. I mean, we had a lot of goofy stuff. We were made to study like astrology and stuff like that. Although my teacher did give us a good foundation in anatomy and physiology. And in those days, people don't believe me, but a lot of schools did not teach it. and they were very much about intuition. But, so I didn't get a lot of goofy ideas about what massage was doing at the time. But then when I got into trigger point therapy, which I drifted away from once I started learning more about the neurobiology of pain and how the nervous system is playing a role there. Um, but you, you really can't escape it. So yeah, there's a, I escaped some of the strange ideas, but, um, yeah, I was taught that it was getting rid of lactic acid. And I learned early from one of my NMT instructors that it wasn't. Um, I think it was about in 1994 or 95 that he said, Oh, by the way, massage is not getting rid of lactic acid and they found that lactic acid is not even what makes you sore. And I said, oh really? And I didn't find that too shocking, you know, because I wasn't running a lactic acid removal business. I just quit saying anything about lactic acid. So, but over time, and I'll tell you when it really stepped up, when I got on the internet, I stumbled across a group of... of physiotherapists and very science-minded massage therapists who knew a lot more about research and science than I did. And it set the bar a lot higher. And that's when a lot of my ideas started being challenged. And I was really taken aback at first. But I also recognized that these people knew more than I did. And I wanted to learn from them. So it was on one hand kind of exciting, but it was a little unnerving. And the crisis came when somebody challenged my ideas on trigger points because I was very invested in them. Like I said, I had assisted at seminars teaching that for 10 years. I'd been practicing it for about 20 years. And even early, I had seen some holes in their hypothesis, but... because nobody else around me seemed to recognize them. I kind of forgot about them, but I started being challenged on that and came to realize. This was something that I finally came to realize. We were being taught hypothesis as if it were fact. And when I, that was kind of a strange thing to go through because I took these things in fact, and they weren't. It was like a conjecture about what's going on. And then I saw that there were a lot of flaws and I don't get into the flaws with it too much with people because it does get very technical. But there's a lot of holes in the true point and hypotheses. So, so we do recognize that people have sore spots that can radiate pain and other sensations elsewhere. But it's the explanation for why that is happening that has some serious flaws in it. And so I backed away from that. But that was kind of a crisis, because that was a foundational concept for me. But in the meantime, I started learning about the role of the nervous system in pain. It was a little hard for me to wrap my head around it in the beginning, but little bit by little bit, I started understanding. So it shifted how I thought about what I was doing. the people that runners that you encounter, are they, they very familiar with Timothy Nokes and his, generator theory of fatigue? I doubt it. I've only, I only just discovered Nokes' work probably a couple of months ago, and that's, you know, eight years into nine years into being a physio now. Uh-huh. Well, um, he, um, got some notoriety for just, uh, find realizing that over-hydration was becoming a problem in, um, like marathon runners, because people were being told so much to hydrate and people didn't recognize that you can over-hydrate and that could cause ill effects. But, um, he, it came up with this idea that he looked at fatigue and he said, well, it's supposed to be, um, a result of, of depletion, you know, of, of glucose or oxygen or whatever. But then there's this experience of people getting a second wind or right at the end of a race that, you know, they get energized. And he put out the idea that maybe fatigue is a sensation generated by the brain to keep us from depletion. And so that kind of dovetails with what's going on in our understanding of pain that A lot of the way we thought about it is, is shifting and that we've come to understand there's not a direct correlation between tissue damage and pain and that the sensations that we feel are, are generated by the brain. Um, I think the listeners have, um, at least I did a whole series on pain science and what the nervous system does and what the brain does to interpret certain pain signals. And I also had another episode on train the brain to endure. And I talked about the Alex Hutchinson's book around endure, which explains Tim Noakes' all his research and work as well. So it's extremely interesting when it comes to how the body interprets pain or interprets like certain severity levels of pain. But you did touch on an interesting point before when talking about um, lecturing and educating yourself or teaching a certain concept and then being quite unnerving when people start to challenge that hypothesis. And I thought what might actually help is I'll talk about my experience when it comes to as a physiotherapist, like delivering a massage, because I remember at uni, we had probably one or two lessons that were dedicated to massage and massage techniques, and that was it. was it for the whole uni and then you were just advised to practice elsewhere. And so they said that massage helps release muscle, it helps increase blood circulation and it helps. We did a little bit of trigger point, but not really. Then we did some trigger point stuff in post-grad, but what was happening is I'd go become a sports therapist and I'd start doing these massage promote that it is helping, it's helping to relax the muscle, lengthen the muscle. It helps to promote circulation. And I was telling my athletes this is because this is what I was trained to, or educated in. Yeah, I was seeing results. I was seeing good results, decreased levels of pain, people were jumping off the table feeling a lot better. And this was confirming my belief that this is actually doing. And could you maybe chime in with my experience, because this is the experience that a lot of therapists have gone through and the better results you see and you see results year in year out and just confirms and solidifies that belief over and over again. What were you starting to hear or what were you starting to experience that was challenging your overall theory of what was actually working? Well, like I said, these physiotherapists were just into everything. anything I said they were challenging it and at a point I am the trigger point one was the one that really Had it I hit bottom I Suddenly realized Possibility that everything I thought I knew was wrong and that is not a comfortable place to be and There are a couple days I went to work I felt like a complete fraud because I realized I had no idea what I was doing and I had to go in and act like I did. And so for about three days I was going to work and just thinking, I have no idea what I'm doing, but I just did what I usually did anyway, just to get by. And after a couple of days, I realized people are still getting up and getting happy and feel good. And like you say, in the past, that was a confirmation to me that what I thought was correct. whatever I was doing with my hands was working pretty well for people. It was how I thought about it. And I don't think it's nearly as necessary for the client to understand these things that it is for the therapist, but how we think about things. Or influences, how we go about doing them or how we experience them. So, um, so getting back to trigger points or things like fascia, people are off at therapists and clients alike. You have to press really hard into it. And if it's not painful, it's not therapeutic because we think we have to destroy these trigger points or stretch this fascia, which is very tough. And when you understand that the nervous system is generating those sensations, you find that you don't have to work so aggressively and make people sore and you're less likely to hurt people. So that was... That was quite the revolution. Sometimes it's tough because the client has either been told by other therapists or other people or they've experienced themselves. Somebody's pushed hard on them and it hurt at the time but then they felt better. But it's not necessarily a great approach. It can work temporarily but it also can end up making the nervous system more sensitive If the tissues are sensitive, we want to calm them down. So I have to spend a little time sometimes talking with them, taking a less aggressive approach. And then when they experience it, they get up and they feel good, they realize, oh, maybe we don't have to cause pain to get rid of pain. So yeah, and even when they experience pain themselves, if you know, if you feel like you just got injured, then obviously you want to pay attention to that. But if you're just experiencing, you know, fatigue or achiness that comes with fatigue, if you understand that's a sensation that you're not doing damage to yourself, you still feel that sensation, but how, but your reaction to it is different. Um, I don't know if that answers the question. It does. I don't think we're getting to like, I don't think we're ever going to get to any like really definitive, like absolute with this sort of conversation. But when we're talking about if you're a massage therapist, you have an athlete in front of you and you're feeling around and they experience like a really intense sensation in one particular spot. And it's very easy for an athlete to believe if they come across a really tender spot and a therapist would say, oh, this is a trigger point. Let me press this and let me release this and you're going to feel a lot better afterwards. It's really easy to believe that because they're like, Oh, wow. I had no idea. I was so sensitive in this area. And then all the while you're having their hands on it to really like, it might be intense, but it might be therapeutic to have someone have their hands on and pay attention to that area. Meanwhile, we're kind of in a way desensitizing potentially when we're addressing that area, which makes them feel a lot better. So how are you? explaining what's happening, how are you communicating with your patient when this type of occurrence does happen? Um, that are you asking like, but when they like people say, you know, oh, I really like a lot of pressure or beat me up or something like that because they feel good afterwards, that kind of addressing that kind of thing. Exactly. And like maybe if someone was to ask, like, what is this actually doing? How is this helping me? What would you say as a therapist? I have no idea. Yeah. Cause I get that. I ask, get asked that all the time. And it's, it's really tough when the evidence doesn't really stack up. I know. Yeah. It's a tough one because, you know, five years ago, well, I guess it's longer than that ago now, but it. time, you know, I had easy answers to all this stuff and now I've told people I know less and less. I'm sure about less and less and by the time I'm 80, I won't know anything. What I tell them is that the nervous system is really in control and I kind of backed Talking about the brain very much until I get to know somebody, just because some people have an odd reaction to it. And it kind of varies with the person. I really try to adapt what I'm saying to the person. So that's the first thing is when they come in to listen very carefully to them and what they're experiencing and what they think about their experiencing and address it. to them. But I, you know, when I tell them is it's, it's the nervous system that it makes us feel, you know, pain that if we feel tension or lack of tension that the nervous system is controlling that and, and people, you know, understand that they can. And so, and I tell them you can't beat the nervous system in the submission. You can't bully it. You have to coax it. So, you know, what is that sensation of tightness that we have? Like one of the things they found is our experience of the sensation of tightness or tension in a muscle doesn't necessarily mean that the muscle is in fact contracting or doing something like that. It's a sensation that we have. And, you know, there's something about touch. when we have our hands on people, we're stimulating those nerve endings that are in the skin and it's sending input to the nervous system. And if the nervous system likes it, it turns down the volume on the sensation of pain, turns down the volume on the sensation of tension. Exactly how that all comes about, we don't really know lots of detail. I think we're going to like the direction we're heading is, is we're not too sure. We're going to end up not knowing anything, but I think any like takeaways, I think we can start to identify or bust a couple of myths that it is not. And you already said earlier in the interview that when not circulating or when up removing lactic acid buildup. Um, another concept that people have is I have, um, knots. I have knots in my muscle that I need to release. What are your thoughts on that? Yeah. And you can even feel sometimes, you know, something that feels like a nodule and exactly what that is. I don't know. You know, I really don't know. You know, when people ask what are knots, I just don't know what to tell them. I don't know. But I know that, you know, when I put my hands on people a lot of times whatever that is that's going on. can feel better. And I don't worry about them. Sometimes people feel something, if there's no pain, they just feel something and they think that there's something wrong. There may not be anything wrong at all. But what is going on is a little collection of muscle fibers that are contracted, or is there something going on at that place where maybe the microcirculation in that area is different? Is there a nerve that's being compressed? And, you know, there's no way for me to know. Yeah. I have to confess a lot of times that I don't know. And you know, this was something in the beginning that when I came to this realization, I was afraid that if I admitted that to my clients, they would think I was stupid. But in fact, they didn't. Quite the opposite. Yeah. They actually, I gained their trust because they knew that I wasn't just going to tell them any made up thing. The other thing I'm hearing a lot is that massage promotes circulation. And this was one thing that I heard at uni because when I'd start massaging a particular area, that skin would go red. And they were like, yeah, this is because we're aiding promote the blood flow and we're aiding circulation and we're promoting all of this stuff. And this is one of the mechanisms why it's working. And do you have any thoughts on that? This is one that if you just think about it, some of these things, if you think at all about the physiology, you can demonstrate to yourself it doesn't make sense. The circulatory system is a closed loop, you know, and so like over a period of time, you know, if we would lose blood, our body would make more blood. But in here now, within the course of a few minutes, your body is not making more or less blood. So you've got a fixed amount and closed system. So what does it even mean to improve circulation? If it means more blood is passing a certain point, like it's traveling faster, well, you need the heart rate to pump faster to do that. And when you're lying on a massage table and you're relaxing, your heart rate's usually dropping. You know, it's so- But then the other thing is that, okay, so if it means more blood in a certain area, well, if you have a closed loop and a fixed amount, that means less blood somewhere else. So what does that mean? You know, it doesn't make any sense. So here's what's going on, I think, is that, yeah, we do see people's skin turn pink. And so the little capillaries in the skin are opening up. and there's more blood there. But then there's gotta be less blood somewhere else. Well, where is it coming from? It's probably coming from the muscles nearby. And this makes physiological sense. Hold on just a second. need a little sip of water there. So here's the thing that you know there's the two broad divisions of the nervous system the sympathetic which is the fight or flight and the parasympathetic which is the rest and digest and the rest and digest one the blood is diverted away from the muscles and towards the internal organs and the skin. which is why when people are very relaxed, they have a nice pink rosy glow in their face. And then when it's in the sympathetic, the fight or flight, it's diverted away from the skin and the internal organs and towards the muscles. So you can run. And so, yeah, if you want more blood in your muscles, you know, it... it's gonna come from somewhere else. And if you want more blood in your skin, it's gotta come from somewhere else. So the whole idea of altering circulation, if you want more circulation, go out and take a walk or a run. But I think what it does do is it makes us feel relaxed. And... One of the most, the area in which we have the most solid evidence around massage is effect on mood, on anxiety and depression. It's pretty well documented and obvious from experience that people feel relaxed. physical state, but also your mental state. There's a marathon runner I used to work with who ended up qualifying for the Olympic trials. And he told me one time, he said, if I just had a fight with my girlfriend, my running is terrible. And so your mental state also affects your physical state and vice versa. So by helping people feel just good in their body, that can... people's experience in their performance. And then, you know, people with pain, it does seem to help at least short term with pain and with feeling of tension. So I think those are some pretty modest claims that we can make, but I've gotten away from making very specific claims because we don't even need them. Like in 28 years, I haven't ever had a single person come in and give their reason for massage that they want to improve their circulation, you know, it's usually they just, you know, want to feel better. They feel tense or anxious and they want to feel more relaxed or they have pain and they want to see if they can reduce it. Um, or they just want a pleasant experience. So yeah, it's a great point to touch on. And yeah, it's a really nice, um, segue into thing and I'll say, well, I don't know, but let's see. Yeah. And when I asked my Patreon supporters to, um, what are their thoughts on massage? I asked like, why do you get a massage? Um, like what do you think is happening and what have you been told is happening? And a lot of the times of what they've been told is kind of like the lactic acid build up, the promote circulation, decrease muscle tension. But when I ask, why do you actually get a massage? I just feel good and it reduces tension. It sort of separates me from the, the working day. It's good for my, like to mentally calm down, um, helps with my stress. I hold stress in my body and the massage helps with that, which makes a whole lot of sense because well, what's it might not actually like the physiology might not make sense, but mentally. You're settling down, you're calming down, you've got hands on, it's usually a warm room, usually just like the sensation. We're very tactile people. We like the sensations on our body and it can help mentally calm us down, which is, makes a whole ton of sense why you're saying the research supports mood, it supports anxiety, it supports depression. And when it comes to us delivering that as a technique, um, that's kind of what we can be. directed our education towards and what we can try and emphasize when we are delivering these techniques. Yeah. You know what, if every single claim about massage, or just, we found out tomorrow was wrong, you know, it, people would still get it because it feels good. You know, it makes them feel good. And that, I, you know, when I had this crisis, I, At a point I thought, I want to try to give up everything I thought I knew, try to get up all my assumptions as well as I can recognize them and start from scratch and think about what do we need? What do we know for sure really? And when I came down to was, you know, I'm really good at making people feel better and some people with pain, I seem to be able to help them have less pain. I thought, you know, if those are the only two things I can say for my, the rest of my professional life, that's not a bad place to be. Um, so the details beyond that, um, you know, like the thing with lactic acid, apparently at some point in the history of physiology, physiologists thought that that's what created the, you know, delayed onset muscle soreness. And for some reason, that little. piece of physiological explanation got out in the public. And later they found out that wasn't the case. But that little piece of information hung in there. So to this day, there are people who think that. And you know, a person just wants to feel better. They just want their soreness to be decreased. You know, when it comes down to it, they don't care physiologically what's going on. So, an awful lot, I just don't worry too much anymore about what's going on underneath the skin. I try to educate myself as much as I can because I, outside of just a professional obligation, I don't wanna do anybody any harm. And I wanna understand how what I do affects a person's body as well as I can. But... You know, the client just wants to feel better. And that's the bottom line. They, yeah. So some of these ideas, I don't worry too terribly much about. There's some that I do because there is the potential to cause harm. When you think that you have to use a lot of pressure to make things change because you think you have to break up adhesions or destroy trigger points. You know, you can injure people and people do get injured. There's a myth out there that there's a pressure point on your ankle that if you stimulate it, that pregnant women can cause them to have a miscarriage. And I think that's a very bad idea to be circulating because if a woman is unlucky enough to have a miscarriage, she might remember a time where she... had an itch or maybe her beaten ankles felt kind of tired and she missized them and she could end up thinking she caused a death of her own baby. So some of them have the potential to do harm. Absolutely. When I'm thinking about, uh, causing no harm and what some warnings might be or some traps that runners might get involved in would be a therapist that is. educating people that makes them dependent on massage or makes them heavily reliant on massage or massage as like a short-term, as a long-term solution and constantly having to come back to that therapist in order to receive the benefits. Cause you did mention massage makes people feel really good but it's most likely a short-term thing. Do you see these traps? Do you see this in common practice? Yeah. And, um, and also in among that are people who've been led to believe that they're a mess and they're full of all these trigger points that have to be, you know, destroyed and that kind of stuff. And, um, you know, making people believe that they're a mess is, is sabotaging them. Um, and, and making people think that they have to depend on us to fix them is it's not good for the client. You know, if you're if you're a client centered therapist, you want to do what's best for the client and fostering dependency is not in the client's best interest. So you know, I don't. I gave up. you know, the idea that anybody needs to see me, if they want to see me, they can, they're free to do that. And there are some people that they find that doing massage regularly fits in for them with keeping themselves feeling at their maximum and they really like that. But I'm not trying to make them feel dependent, I don't... I don't foster that and it's, and I want them to understand that that's a choice and that they can change it every time or at any time. But yeah, I don't, I don't, I don't judge my success by how regularly somebody sees me or, or how I because. That might be, that might be an indication that we're not being successful. It's sometimes, you know, somebody with a chronic pain problem will come and see me and said, Oh, I had this really great therapist, you know, I've been seeing them every week for seven years and they still have the same pain. Yeah. And I'm thinking, well, the bull was so great about the, you still have the same problem, you know, and, um, I don't say that to them, it would be kind of rude, but that's what I'm thinking. Um, I, my goal is, is for the client to, to help them understand what they can do to keep themselves feeling good. Um, so if they want to come back to can, but I'm not going to try to create that dependency and, and if they start expressing that, you know, I'm saving their life or something, it's like, I try to, I try to diplomatically, um, untangle that idea. I don't, I don't think it's good for the client. Yeah. Well, that's the point. Isn't it? It's about the right education and kind of like an informed consent approach to massage therapy. And you touched on a whole bunch of points there. I've, I think fear is a big motivator. It's easy to motivate someone with fear. And if someone's laying down the table and push on a, a tight point, they're like, Oh, what's that? And they say, Oh, this is a trigger point that's connected to your elbow. And you're getting elbow pain because you've got this trigger point up here. Let me release this and let me do this. Oh, let's have a look at your shoulder. So I surface said that. And then there's like, it creates fear. It's like, Oh my God, I have all these trigger points that are triggering all this pain and that's it's very easy for a therapist to communicate that way. And it's very, because it is a motivator for them to come back, be like, I need to get this sorted out. My elbow pain is back. Maybe these trigger points are firing up. And unfortunately. a lot of practices do measure their success on how many patients they see, or they're pushed by their superiors to continuously stay busy and motivate them to keep coming back, which is a real danger. And when we come to runners and we address runners who are seeing these therapists with running injuries, we need to be really careful as runners and educate ourselves as runners to avoid. like this sort of communication, like you need to rely on this hands-on therapy every week for several months. And if pain keeps coming back. Or you're in big trouble, you know? Yeah. But you know, if you don't, you know, some ticking time bomb is going to go off. You know, here's the thing. I... Is that... There's a lot of... bad information circulating in the size world. Our education is pretty minimal and pretty poor, at least in the United States. And I've been committed for a long time to trying to get accurate information out to people. And a lot of massage therapists don't like that because let's face it, who likes to find out that our cherished beliefs could be wrong? It's not fun. but I think our greater commitment should be to the client and to have an accurate understanding. And I got over my upset. Now it's like, I find out that somebody corrects me, somebody who knows more than I do corrects me. I'm like, oh, thank you, because I wanna be right. But besides that, I'm committed to giving my clients accurate information. One of the things I was asked to give a talk about, shit massage therapists say, to a group of massage therapists that could have easily ticked off. The thing that I said that people came up to me later and said really got their attention is that if we don't give our clients accurate information, they can't give informed consent. That caught their attention. I kind of use that as an appeal. Look, we have an obligation to give people accurate information. We need to be a little more careful about what we say and think about it. I'd rather say, I don't know, than make up a story. You know, that probably isn't going to be true. So yeah, people believing that they're a mess without us is... it's not good for them. If somebody was not in a runner, had a race coming up and they weren't able to get their massage and they're gonna go in feeling all anxious because they're quite sure that these trigger points are gonna go off all over the place on them, that's not very helpful. They're ticking time bomb. Yeah, you want them to be confident and have trust in their body and have optimism. Absolutely. I think we found the balance in this topic of the good and the bad of massage and mostly the bad. But the, the good part being that like, if I was, thankfully I do only online physio these days, but if I was back in clinics, I would definitely still massage people are definitely if they were injured, um, if they had knee pain, if they had shin splints, I'd definitely start doing some dry needling and massage because like we said, it. it helps like it reduces pain and makes people feel better. The mechanism of why they feel better is up in the air. But what we do is if I do some massage techniques and that gets your pain levels down to like significantly lower, that allows you to then go home and do more exercises and more loading and more of these longterm strategies. If you can do that more effectively, then that's a better strategy in the long run because you're able to start or you're able to do more of these rehab strategies that have been proven to work and do start to tip you towards the aim for longer term goals and like longer term strategies and I think that's what a runner who is coming in seeing a massage therapist or who is injured and seeing a Manual therapist should keep in mind Yeah, and you know as you're saying that I thought about Adam Meekins, who I adore. I am a fan girl. And there are a lot of manual therapists who are really disturbed because he's pretty much opposed to manual therapy. And I completely understand his reasons why. And a lot of it is dependency and that it's a passive thing. And as you're saying, it's a lot of things. In my way of thinking, there are some potential dangers there, but I also see that it can create some optimism that maybe the relief I give somebody is going to be short-term, but for them to experience feeling better in their body, can them... give them the idea that, oh, they're not stuck in this pain, that they actually could feel better and to have the experience of feeling more comfortable in their body is, you know, I will tell them if you've done this once, you can do it again and try to build on that. And then maybe they will be more inclined to do their exercise or whatever it is that they should be doing to rehabilitate themselves. So I think there's a legitimate place there for it. And especially people with some chronic pain conditions that maybe are not really gonna go away. Even for some people to even get a little temporary relief is really useful to them. So I think that we can do it with integrity, but we always need to keep center and forefront the well-being of the client. What is best for the client? When you're in a fee-for-service situation, it's hard not to think about, you gotta pay the rent and stuff. So how do you do that and keep your integrity? I think it's quite possible. I don't recommend that anybody ask me for advice around business because I'm not a good business person, but I can direct them to people who I do think are very successful business-wise and do it with integrity and point to them and say, here, go talk to that person. Talk to me about physiology and how pain works and fascia. I think we have covered so much today and I think we have, like the overall message would be just to avoid falling into these traps because that can be significantly like detrimental to your wellbeing and to your recovery if you are injured. But as we wrap up today, are there any other messages that we haven't discussed that you think that runners should know when it comes to massage therapy? Are they big on fascia? Let's assume they are. Okay, because here in the United States, fascia is a big focus of attention. And the bottom line is fascia, I don't know how much runners know about the function of fascia, but basically it's like to contain like your muscles, you know, and also to transmit forces. Um, you know, the, if it's sort of containing a muscle and, and all your muscle fibers contract and it's helping to transmit that, that force, that pulling force. And so those are kind of its two main functions and people get the idea that it gets tight and then it has to be stretched, but it's not contractile. The muscle fibers are contractile, but the fascia itself is not. And it's very tough. You cannot stretch it. It's as tough as Kevlar. And so there's a lot of sometimes brutal therapy that's done to people under the guise of stretching their fascia or breaking up adhesions and you can't do either one. And people will say, well, but I do this thing and I feel it changing. And my response to that is, I know you feel a change, the therapist feels a change, the client feels a change. But what I'm saying is the explanation for the change is not what you think it is. And so what's really, so what's something we do know is when we have our hands on people, it stimulates nerve endings and sends impulses to the brain and brain processes them and makes changes. That's what's making the change. And that's something we know pretty solidly. I mean, the details of how that goes about comes about, you know, may not be well understood, but that basic thing that's going on has been understood for, gosh, since the mid 1800s. And there's mountains of evidence to support it. So. What I would say to runners is don't let people brutalize you in the name of, you know, fixing your posture or your, your trigger points that you massage doesn't have to hurt to be therapeutic. And in fact, when you hurt people, you know, what does the nervous system do in response to pain? It, it tenses up, you know, it causes a stress response, you know, you want to make the body feel good. So that's a big one that's out there, at least here, lots of focus on doing- I think a concept that they can draw to would be to the ITB as well. ITB is just thick fascia, and people believe that it's tight, they believe that it needs to be released. So they use the foam roller, they get massages, they do all these sort of things to try and release it. You're not releasing anything, it's not a- contractile property doesn't have anything. So you can't release it. Now you may feel it different, you know, you may feel a sensation of tightness and then you don't. But what's changed is how your nervous system is responding, you know, what kind of sensations it's generating. But yeah, that's one that ends up causing people a lot of pain and... The more you cause pain, you're irritating nervous system, and the more you irritate it, you run the risk of having that kind of boomerang and get over sensitive. So sometimes it can feel good to do that, but it's not a great idea to over rely on it. There are other ways. Just putting your hand. over the area, you know, flat on your skin and putting a stretch on it and holding that, you know, for a minute or two can do a lot to, you know, if you feel a tightness there, try that. It's not going to hurt you. And it's surprising how that can often dial down the volume on pain or tension. Um, your career and your attitude and your mindset has fit into the philosophy of this podcast. So nice. And I admire that the fact that you have like, tried to break out of your own like beliefs and your own discipline of what you've believed to be true for so long. And I've seen it in like therapists of any discipline that you learn a certain thing, you have these beliefs. And then once you get out into practice, as soon as someone challenges your belief. most people get defensive and start attacking and start going in the opposite direction that you went, which was actually challenging your own ideas and coming in with an open mind and having the confidence to say, I don't know, and then try and look for an answer instead of at the risk of coming across feeling stupid, you've decided to have this emotional intelligence, this unbiased opinion and seek out your career that way, which is very... Like I admire that very much. And it's hopefully a big weight off your shoulders. Hopefully you're feeling, um, you might not be the best business woman, but at least your, your conscience is probably, um, high up there than a lot of other therapists. And so I really admire that approach that you've taken and I really, um, I'm blessed to have you on as a guest to explain exactly what you have learned. And, um, yeah, I want to say thanks for coming on. Well, thank you and thank you for your kind words. And you know what I think saved me is that I'm good at recognizing people who know more than I do. And so even though I would get taken aback, I recognize that those people knew more than I did and I wanted to know what they knew. And that's what carried me forward. Yeah. And it's, it's almost like you're putting your ego in the backseat as well. Whereas others are very ego driven that go in the opposite direction. Yeah. Very good. All right, Alice, I'll, uh, we'll finish up there. Thanks again for coming on. Well, thank you so much for having me. It's, it's been delightful. Thanks for listening to another episode of the Run Smarter podcast. I hope you can see the impact this content has on your future running. If you appreciate the mission this podcast is creating. It would mean a lot to me if you submit a rating and review. If you wanna continue expanding your knowledge, please subscribe to the podcast and get instant notifications when a new episode comes out. If you want to learn quicker, then join our Facebook group by searching the podcast title. If you wanna take your learning to the next step. including injury prevention principles, injury specific insights and modules to boost your running performance, then head to our website by searching runsmarter.online and jump into our Run Smarter Online course. Once again, thank you for listening and becoming a Run Smarter Scholar and remember, knowledge is power.